Provider First Line Business Practice Location Address:
1945 HIGHLAND PIKE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
FT WRIGHT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-8127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-331-4005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2011